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Abstract HTML Views: 107 PDF Downloads: 132 Total Views/Downloads: 239
Objective: We examined the clinicomorphologic factors associated with the low- and high-risk of generalization
of cardioesophageal cancer (CEC) (T1-4N0-2M0) after complete (R0) esophagogastrectomies (EG) through left thoracoabdominal
Variables selected for 5-year survival (5YS) study were input levels of 45 blood parameters, sex, age, TNMPG, cell type,
tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of CECP
were evaluated using a log-rank test. Multivariate Cox modeling, multi-factor clustering, structural equation modeling,
Monte Carlo, bootstrap simulation and neural networks computing were used to determine any significant dependence.
Results: For total of 175 CECP overall life span (LS) was 1381.6 ± 1486.7 days, (median - 723 days) and cumulative 5YS
reached 36.1%, 10 years - 26.6%. 53 CECP lived more than 5 years without CEC progressing. 104 CECP died because of
CEC during the first 5 years after surgery. 5YS of CECP was superior significantly after AT (69.9%) compared with surgery
alone (26.6%) (P = 0.000 by log-rank test). Cox modeling displayed that 5YS of CECP (n = 175) after complete EG
significantly depended on: phase transition (PT) early-invasive CEC, PT N0-N12, AT, age, T, tumor growth, Rh-factor,
blood cell subpopulations, cell ratio factors (P = 0.000-0.047). Neural networks computing, genetic algorithm selection
and bootstrap simulation revealed relationships between 5YS and early-invasive CEC (rank = 1), PT N0-N12 (rank = 2),
AT (rank = 3), T (4), gender (5), prothrombin index (6), weight (7), glucose (8), age (9), coagulation time (10), eosinophils/
cancer cells (11), erythrocytes/cancer cells (12), hemorrhage time (13), protein (14), Hb (15), segmented neutrophils/
cancer cells (16), stab neutrophils/cancer cells (17). Correct prediction of 5YS was 100% by neural networks computing
(error = 0.0009e-12; urea under ROC curve = 1.0).
Conclusions: Best treatment strategies for CECP are: 1) screening and early detection of CEC; 2) availability of very experienced
thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and
adequate abdominal, mediastinal, cervical lymphadenectomy for completeness; 4) high-precision prediction; 5) adjuvant
chemoimmunotherapy for CECP with unfavorable prognosis.